From the Guidelines
Management of slipping rib syndrome typically begins with conservative approaches, including rest, activity modification, and over-the-counter pain medications such as NSAIDs, before considering more invasive options. The goal of treatment is to alleviate pain, reduce inflammation, and improve quality of life. Initial treatment may include:
- Rest and activity modification to avoid exacerbating the condition
- Over-the-counter pain medications such as NSAIDs (ibuprofen 400-600mg three times daily or naproxen 500mg twice daily) for pain relief and to reduce inflammation
- Physical therapy focusing on core strengthening, posture correction, and intercostal muscle stretching to improve stability and reduce pain
- Heat or ice therapy applied to the affected area for 15-20 minutes several times daily to help manage symptoms
For more severe pain, intercostal nerve blocks using lidocaine 1-2% with or without corticosteroids can provide temporary relief 1. If conservative measures fail after 3-6 months, more invasive options may be considered, including prolotherapy injections to strengthen the costal attachments or surgical intervention such as costal cartilage excision for persistent cases. However, surgery is typically reserved for patients with debilitating symptoms that significantly impact quality of life. The condition occurs when the cartilage connecting the lower ribs to the spine weakens, allowing the ribs to slip and irritate surrounding nerves and tissues, which explains why strengthening exercises and stabilization techniques are central to treatment. According to the most recent study 1, surgical stabilization of rib fractures can be beneficial in improving clinical outcomes and reducing morbidity and mortality. However, the management of slipping rib syndrome should be individualized, and the decision to proceed with surgical intervention should be made on a case-by-case basis, taking into account the patient's overall health, symptoms, and quality of life.
From the Research
Diagnosis of Slipping Rib Syndrome
- Slipping rib syndrome is mainly diagnosed clinically, with the "Hooking Maneuver" being a useful physical examination technique for confirmation 2, 3, 4, 5
- Dynamic ultrasound can also be used to identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling 3, 4, 5
- Definitive diagnosis can be made with pain relief on nerve block, visualization of altered anatomy during surgery, and relief after surgical correction 4
Treatment Options
- Conservative therapy, including rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs), is often the initial treatment approach 2, 4
- Intercostal nerve block and injection therapy with local anesthetics and steroids can provide symptomatic relief 2, 4
- Surgical correction, including resection of the slipping rib cartilages, is the definitive treatment for slipping rib syndrome 2, 3, 4, 5
- Emerging options, such as rib stabilization, may be considered for recurrent symptoms 5
- Other treatments, such as physical therapy, osteopathic manipulative treatment, and botulinum toxin injections, may also be attempted 3
Management and Care Plan
- The management and care plan for each patient with slipping rib syndrome must be individualized based on presenting symptoms and medical history 2
- Early recognition and prompt intervention are crucial to prevent unnecessary tests and procedures, and to improve patient outcomes 2, 5
- A comprehensive review of the patient's history, including previous trauma or abdominal surgery, is essential to consider slipping rib syndrome as a potential cause of upper abdominal and lower thoracic pain 6